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By Jason Mann No BS pulmonary critical care fellow
Olga Baraldi, Chiara Valentini, Gabriele Donati, Giorgia Comai, Vania Cuna, Irene Capelli, Maria Laura Angelini, Maria Ilaria Moretti, Andrea Angeletti, Fabio Piscaglia, Gaetano La Manna
Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice...
November 6, 2015: World Journal of Nephrology
Louis Jamtgaard, Sara L Manning, Brian Cohn
No abstract text is available yet for this article.
April 2016: Annals of Emergency Medicine
Mitra K Nadim, John A Kellum, Andrew Davenport, Florence Wong, Connie Davis, Neesh Pannu, Ashita Tolwani, Rinaldo Bellomo, Yuri S Genyk
INTRODUCTION: Renal dysfunction is a common complication in patients with end-stage cirrhosis. Since the original publication of the definition and diagnostic criteria for the hepatorenal syndrome (HRS), there have been major advances in our understanding of its pathogenesis. The prognosis of patients with cirrhosis who develop HRS remains poor, with a median survival without liver transplantation of less than six months. However, a number of pharmacological and other therapeutic strategies have now become available which offer the ability to prevent or treat renal dysfunction more effectively in this setting...
February 9, 2012: Critical Care: the Official Journal of the Critical Care Forum
Vanessa Stadlbauer, Vanessa P Stadlbauer, Gavin A K Wright, Murad Banaji, Ashis Mukhopadhya, Rajeshwar P Mookerjee, Rajeshwar Mookerjee, Kevin Moore, Rajiv Jalan
BACKGROUND & AIMS: It has been proposed that activation of the sympathetic nervous system causes a rightward shift in the renal autoregulatory curve such that renal blood flow is critically dependent on renal perfusion pressure and that this contributes to the development of the hepatorenal syndrome. The aims of the study were to determine the relationship of renal blood flow and renal perfusion pressure in patients with liver cirrhosis and the effect on renal hemodynamics following insertion of a transjugular intrahepatic portosystemic shunt (TIPS)...
January 2008: Gastroenterology
Juan Carlos Q Velez, Paul J Nietert
BACKGROUND: Vasoconstrictor therapy has been advocated as treatment for hepatorenal syndrome (HRS). Our aim was to explore across all tested vasoconstrictors whether achievement of a substantial increase in arterial blood pressure is associated with recovery of kidney function in HRS. STUDY DESIGN: Pooled analysis of published studies identified by electronic database search. SETTING & POPULATION: Data pooled across 501 participants in 21 studies...
December 2011: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Fabrizio Fabrizi, Alessio Aghemo, Piergiorgio Messa
Hepatorenal syndrome is a complication of end stage liver disease. It is a unique form of functional renal failure related to kidney vasoconstriction in the absence of underlying kidney pathology. Hepatorenal syndrome is classified into 2 types: type-1 HRS shows a rapid and progressive decline in renal function with a very poor prognosis (median survival of about 2 weeks); type-2 HRS has a more stable kidney failure, with a median survival of 6 months; its main clinical manifestation is refractory ascites. The most appropriate therapy for HRS is liver transplantation but only a minority of HRS patients undergo the procedure due to the high mortality; survival among liver transplant recipients is lower in HRS than among their counterparts without HRS...
2013: Kidney & Blood Pressure Research
Andrew Davenport, Jawad Ahmad, Ali Al-Khafaji, John A Kellum, Yuri S Genyk, Mitra K Nadim
Hepatorenal syndrome (HRS) is defined as the occurrence of renal dysfunction in a patient with end-stage liver cirrhosis in the absence of another identifiable cause of renal failure. The prognosis of HRS remains poor, with a median survival without liver transplantation of <6 months. However, understanding the pathogenesis of HRS has led to the introduction of treatments designed to increase renal perfusion and mean arterial blood pressure using vasopressors and albumin, which has led to improvement in renal function in ∼50% of patients...
January 2012: Nephrology, Dialysis, Transplantation
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